P-5.6. E-prescribing

Electronic prescribing (e-prescribing, or eRx) allows a prescriber to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy. It also provides the ability to verify eligibility and formulary data for people, prior to and during the prescribing process, and view medication history for the previous 12-month period. This is enabled with the authorized exchange of data between the payer and the prescriber. Full support of e-prescribing is available for traditional Medicaid, CSHCN, KHC, and HTW claims (via SureScripts) and for Medicaid managed care pharmacy claims.

Brand Medically Necessary

If an e-prescription is received by a pharmacy with “dispense as written” (DAW) indicated but without the free text message ("Brand Medically Necessary") or additional note, pharmacy providers must contact the prescriber for a new prescription. Once the pharmacy receives the e-prescription with both data elements, the prescription may be transmitted with the values below. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.

Field Name Field Number Usage
Dispense as Written 408-D8 Enter "1" (Substitution Not Allowed by Prescriber)
Prescription Origin Code 419-DJ Enter "3" (Electronic)

Failure of the pharmacy to produce electronic records indicating the proper DAW and “Brand Medically Necessary” in the free text message for the prescription will result in the claim subject to recoupment. All non-electronic “Brand Medically Prescriptions” (for controlled and non-controlled substances), must continue to comply with current policy and Texas State Board of Pharmacy rules.